Healthcare Provider Details

I. General information

NPI: 1083031256
Provider Name (Legal Business Name): PENNY SHIPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 E WOODRUFF AVE
TOLEDO OH
43604-5342
US

IV. Provider business mailing address

544 E WOODRUFF AVE
TOLEDO OH
43604-5342
US

V. Phone/Fax

Practice location:
  • Phone: 419-242-9577
  • Fax:
Mailing address:
  • Phone: 419-242-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN227988
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: